I joined the RCHN Community Health Foundation in the summer of 2007 as Director of Technology Research. My role at the Foundation, as explained in my first column (9/07), was and continues to be to advance the organization’s technology vision, which centers on providing CHCs with affordable access to the technology infrastructure needed to provide clinical care and support operations. At that time, we said: “The bottom line: the Foundation wants to keep you advised on technology usage and trends. We want to help you develop knowledge to influence policy and advocate for the best technologies to benefit your organizations. The goal is to help CHCs become more effective and improve clinical care and operations.”

Since then, starting in November 2007, we’ve published a series of columns on the following topics:

  • Hardware, software and network infrastructure needed to support clinical and business operations at CHCs;
  • What software standards are, and which ones are important for CHCs;
  • The importance of software interoperability and the technical implementation of integration among software products for CHCs;
  • The implications of productivity in ambulatory care organizations for HIT adoption, workflow redesign and organizational restructuring for CHCs, especially in the context of EHR adoption; and
  • A realistic look at open source software and the possibility of its use in CHCs.

In addition, I’ve written a column for the NACHC Forum, made several presentations at NACHC conferences on the means of improving technology adoption in CHCs. I have also co-authored (with Matthew Grob of RSM McGladrey) an Information Bulletin in the NACHC Health Center Controlled Network Series entitled ‘Health Centers and the Data Warehouse’1 . In the past year, I’ve concentrated on the hardware and software that can improve how CHCs work and the related topics of software standards, open source alternatives and the challenges of interoperability and software integration.

What’s next? What are the technology topics and trends that are and will become increasingly important to CHCs in the near and medium-term future? Although in the past year I’ve written mainly about the actual technology that’s relevant to CHCs, the innovations and advantages from technology in the next few years will be at least as much about how technology is used as about changes in the technology itself. Of course, changes in use are not independent of changes in the capabilities that technology offers, nor are they separate from the creation of new uses for existing technologies. My emphasis for the next year and beyond will therefore be on finding productive uses for both new and existing technology, as well as what new technologies (mainly software and integration technologies) are most relevant to health centers.

The two areas in the use of technology I think will be most important in the next year or so are how information is used in health centers and health information exchange (HIE). I’d like to preview these trends here, as they will be the focus of the columns I’ll write over the next several months.

Information use in health centers
Health centers generate substantial amounts of information, and both the use of existing technology and the adoption of new technology will lead to increases in the sheer volume of information. The challenge is handling the amount of information in circulation, and using it effectively as it is generated by various systems and applications. For example, patient demographic and billing information is generated and managed by practice management systems. Clinical and billing information is generated and managed by EHR systems. Financial and business logistics information is generated and managed by accounting and general ledger systems.

Sometimes it’s easy to get caught up in the production of information and the details of all the software that generates it. The reason we deal with these details and produce this information, though, is not that the technology is an end in itself, but that it is a means to an end. Aligning technology with the goals of your health center allows you to look beyond specific pieces of data for new combinations and new uses of data, as well as new sources of data that will help you meet your goals The goal is to both increase the efficiency of our business operations, and more importantly, to improve clinical outcomes for our patients. If we keep these goals in mind, we can begin to see how to use this technology and the information it produces effectively and productively. Exploring the productive use of this information will be a major focus in future columns.

Health information exchange
Local and regional exchange of health information is a current focus of organizations from the federal and state levels all the way down to individual health centers. The reason for this focus is not, as it sometimes appears, technology for its own sake, but the very real possibility that such information sharing will greatly improve access to health care and clinical outcomes for a broad range of people – especially for underserved and at risk populations.

HIE is a difficult technical problem, but experience has shown that the key issues related to HIE are not technical but rather social and cultural issues such as legal liability, privacy and security, and the tendency of organizations to resist or delay sharing of information that is considered proprietary or strategic to them. I’ve been involved in some of the most visible HIE efforts – both successes and failures – in the last decade, and I’ll try to present the context as well as technical and non-technical issues of HIE for health centers in a series of future columns.

Well, there it is – a look back over the past year and a look forward to the trends in technology and its use that will, in my humble opinion, be important for health centers in the next year. As always, the Foundation will keep its finger on the pulse of technology evolution and will report to you on new and ongoing issues and events. Keep on reading, and I hope to see you IRW (in the real world).

David Hartzband, D.Sc., is Director for Technology Research at the RCHN Community Health Foundation and a Research Scholar in technology and organizations in the Engineering Systems Division at the Massachusetts Institute of Technology.